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PubMedDate not supplied

Computed tomography of omental pathology.

Computed tomographic scans were reviewed in 46 patients with documented omental pathology to analyze the radiographic characteristics of benign and malignant disease. The normal omentum is identified on CT of the abdomen as a homogeneous fat density anterior to the transverse colon. Four distinct patterns of omental pathology were identified: (a) omental caking, (b) finely infiltrated fat with a "smudged" appearance, (c) cystic masses, and (d) discrete nodules. The smudged pattern of omental pathology was identified most frequently; it was present in 20 to 39 patients with malignant disease and in five of seven patients with inflammatory disease. Omental caking was present in 17 of 46 patients but was only identified in malignant disease. Computed tomography provides the most reliable radiographic technique to routinely evaluate omental pathology. A thorough understanding of the variable appearance of omental disease is important in identifying omental pathology.

Adolescent↗
PubMedDate not supplied

Epiploic appendicitis: CT characteristics.

Acute infarction of an appendix epiploica resulted in an inflammatory process involving the caudal aspect of the transverse colon and the adjacent greater omentum. Computed tomography demonstrated prominent linear soft tissue densities, an increase in CT number of the involved greater omentum, and posterior displacement of the small bowel. In the setting of acute abdominal pain the location and focal nature of the inflammatory process as seen on CT may allow the radiologist to suggest the correct diagnosis.

Colitis↗
PubMed1985

Arteriovenous malformations as a cause of gastrointestinal bleeding: the importance of triple-vessel angiographic studies in diagnosis and prevention of rebleeding.

Arteriovenous malformations of the gastrointestinal tract are a source of upper and lower gastrointestinal bleeding. We studied 40 patients with arteriovenous malformations. Eighteen percent had single lesions in either the distal transverse colon or the left colon (the angiographic distribution of the inferior mesenteric artery). Seventeen percent had concomitant colonic and extracolonic arteriovenous malformations. Only 6% of those who underwent surgery for removal of arteriovenous malformations rebled. We also studied the incidence of angiodysplastic lesions of the colon of 159 patients over the age of 55 with lower gastrointestinal bleeding; associated arteriovenous malformations were present in 21%. These data suggest: that to evaluate arteriovenous malformations as a cause of gastrointestinal bleeding, one must perform inferior and superior mesenteric and celiac angiography; the incidence of rebleeding is reduced when triple-vessel selective visceral angiography precedes surgical removal of arteriovenous malformations; and the incidence of associated arteriovenous malformations approaches that of diverticulosis in elderly patients with lower gastrointestinal bleeding.

Adult↗
PubMed1986

Retained stool as a guide to the site of severe rectal bleeding.

Despite improvements in diagnostic techniques including the use of radionuclide imaging, locating the site of severe rectal bleeding is not always possible. We present two patients in whom a survey film of the abdomen showed a dense accumulation of stool in the transverse colon. Subsequent evaluation confirmed that the source of rectal bleeding was distal to this area. Accordingly, the presence of a fecal impaction in the colon strongly suggests that the site of active bleeding lies more distally. In these circumstances, diagnostic measures should be directed to the segment of the colon distal to the impaction.

Adult↗
PubMed1995

Reconsidering the diagnosis and treatment of patients following ingestion of liquid lye.

Concentrated lye rapidly produces liquefaction necrosis, which can completely dissolve organs of the upper gastrointestinal tract, damaging adjacent structures including, in rare instances, even the transverse colon. Patients so afflicted will survive only if the injury is promptly detected and treated by radical surgical extirpation of all necrotic tissue. Symptoms are unreliable, and definitive diagnosis requires endoscopic evaluation. For years endoscopists were warned to stop at the first site of injury to avoid perforation of the damaged esophagus, but fiberoptic instruments now allow panendoscopy to be safely performed in almost all cases. Endoscopy alone, however, cannot detect extraluminal injury. If there is visual evidence of injury to the duodenum, computed tomography should be routine to search for injury to adjacent structures. Even in the absence of duodenal injury, computed tomography may prove valuable in assessing and managing patients with extensive damage to the esophagus or stomach. In cases of mediastinal or intraabdominal visceral necrosis, steroid therapy, by depressing the patient's ability to mount an inflammatory response, might worsen the injury and lead to life-threatening sepsis. The use of corticosteroids to treat patients following ingestion of caustic substances should therefore be abandoned as both ineffective and potentially dangerous.

Burns, Chemical↗
PubMed1978

Traumatic intrapericardial rupture of the diaphragm.

A 60 year-old woman sustained an intrapericardial rupture of the diaphragm with herniation of a loop of transverse colon into the pericardium. There are ten previous reports of this condition. Reduction of the hernia and repair of the defect were readily accomplished through an upper midline abdominal incision.

Colonic Diseases↗
PubMed1980

Omental transposition as an aid in genitourinary reconstructive procedures.

Mobilization of an intact omental pedicle graft for supportive use has been carried out in a variety of genitourinary reconstructive procedures. Mobilzation is accomplished by detachment of the omentum from the transverse colon and by separation from the greater curvature of the stomach. The right gastroepiploic artery is generally preserved as the blood supply to the omental pedicle. Further pedicle lengthening can be achieved as necessary by selective division of the omentum, based on the arterial anatomy. The rich vascular and lymphatic supply of the omentum and its attendant potential to contribute to healing, even in the presence of infection, while maintaining its suppleness and allowing epithelization to occur over its surface, makes the omental pedicle graft an extremely useful adjunct in the following difficult situations: complicated vesicovaginal, prostatorectal, and rectovaginal fistulas; reconstruction of the bladder neck and bulbo-membranous urethral areas; extensive injury to the bladder; and a variety of renal and ureteral reconstructive procedures.

Female↗
PubMed1981

Intestinal injury associated with low-voltage electrocution.

A 16-month-old girl suffered low-voltage electrocution from a hairdryer while playing in the bathtub. At exploratory laparotomy about 18 hours postinjury because of distention and persistent, unexplained acidosis, a 1.5-cm diameter necrotic lesion in the terminal ileum surrounded by multiple superficial serosal burns and a 1.5 x 1.0 cm eschar in the mid-transverse colon were found. The lesion in the small intestine was resected with wide margins and the colon lesion exteriorized. The child ultimately expired 12 hours after surgery from recurrent cardiac arrest. Abdominal visceral injury associated with major electrical injury is reviewed. Although the colon is probably the most frequently injured, the esophagus, pancreas, gallbladder, and small intestine have also been reported as directly injured by electric current. The importance of meticulous examination of the abdominal contents at laparotomy is stressed. Lesions of the small intestine should be resected with wide margins when possible and lesions of the colon resected with a colostomy of the injured segment exteriorized.

Baths↗
PubMed1984

Prostacyclin selectively enhances blood flow in areas of the GI tract prone to stress ulceration.

This study assessed the effect of continuous infusion of prostacyclin on tissue blood flow throughout the GI tract to see whether small and large bowel flow was also affected. Twelve miniature swine were anesthetized, ventilated, and hemodynamically monitored. After stabilization each animal received either prostacyclin in buffer at 0.1 mcg/kg/minute for 3 hours or buffer alone (controls). Tissue blood flow was documented at baseline and at 1, 2, and 3 hours of prostacyclin infusion by injection of radiolabeled spheres. Prostacyclin infusion did not significantly affect mean arterial pressure, heart rate, or cardiac index compared to controls. At 3 hours tissue blood flow was significantly increased in the gastric mucosa (225%), small bowel (110%), cecum (260%), and transverse colon (160%) compared to controls. Prostacyclin may be an effective agent for prevention of ischemia in all areas of the GI tract prone to stress ulceration.

Animals↗
PubMed1993

Traumatic ventral abdominal hernia associated with small bowel gangrene: case report.

A rare case is presented of traumatic subcutaneous rupture of the rectus abdominis with ventral herniation and decollement of the jejunum and transverse colon. Irreversible ischemia of the small bowel had occurred following a large mesenteric avulsion. Computed tomographic scanning detected the parietal defect and identified the herniating viscera.

Abdominal Muscles↗
PubMed1980

Eosinophilic infiltration of the stomach.

An unusual case of eosinophilic infiltration of the proximal stomach with direct extension into the left hemidiaphragm, liver, and transverse colon is described. Because the lesion was unresectable, a trial of steroid therapy was begun, with an initially good clinical response. Subsequent extensive tumor necrosis and accompanying diaphragmatic perforation, autolysis of the left lower lung, and a chronic gastropleurocutaneous fistula led to death. This case underscores the aggressive nature which this "histologically benign" neoplasm can pursue.

Aged↗
PubMed1990

Unusual cause of traumatic diaphragmatic hernia in a 12-year-old boy.

A 12-year-old boy with a short history of dyspnea and occasional left-sided chest pain was discovered to have a diaphragmatic hernia that apparently resulted from minor chest trauma two years earlier. A large portion of the small bowel, part of the transverse colon, and the entire omentum were found in the left side of the chest. The patient recovered uneventfully after primary repair of the diaphragm. Although such lesions are usually associated with relatively severe injuries, this case shows that they may result from any type of chest trauma.

Accidents↗
PubMed2000

Overlap syndrome between autoimmune hepatitis and primary sclerosing cholangitis in two cases.

The overlap syndrome between autoimmune hepatitis and primary sclerosing cholangitis is a rare condition and only few cases have been published, partly associated with ulcerative colitis, but not with Crohn's disease. We report an autoimmune hepatitis/primary sclerosing cholangitis overlap syndrome in a female patient with Crohn's disease. In addition, a second case of overlap syndrome is reported in a man without inflammatory bowel disease. A 24-year-old woman was referred with a 10-month history of diarrhoea and biochemical changes including elevated serum levels of alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase and immunoglobulin G. Enzyme linked immunosorbent assay showed that antinuclear autoantibodies were elevated. Immunofluorescence for perinuclear-staining antineutrophil cytoplasmatic antibodies was positive. Diagnostic criteria of definite autoimmune hepatitis according to the International Autoimmune Hepatitis Group were fulfilled. Liver biopsy simultaneously showed criteria of autoimmune hepatitis and primary sclerosing cholangitis. Endoscopic retrograde cholangiography demonstrated features of primary sclerosing cholangitis. Colonoscopy and colonoscopic biopsies indicated an active Crohn's disease affecting the terminal ileum and the ascending and transverse colon. Furthermore, we report the case of a 28-year-old man with known primary sclerosing cholangitis for the previous 6 years, and who developed jaundice and a marked increase of aspartate aminotransferase, alanine aminotransferase and immunoglobulin G, leading to the diagnosis of definite autoimmune hepatitis. A review of the literature revealed only 16 cases of an autoimmune hepatitis/primary sclerosing cholangitis syndrome in patients without inflammatory bowel disease or in association with ulcerative colitis. We report two additional cases, one case showing an association with Crohn's disease.

Adult↗
PubMed2004

Middle colic artery thrombosis as a result of retained intraperitoneal gallstone after laparoscopic cholecystectomy.

Spilled gallstones during laparoscopic cholecystectomy are associated with a number of complications such as infection, abscess, inflammation, adhesions, cutaneous sinuses, small bowel obstruction, incarcerated hernia, and generalized septicemia. We report a case of a patient with middle colic vessel erosion and thrombosis secondary to a retained gallstone following laparoscopic cholecystectomy 11 years ago. At operation, the patient was found to have a necrotic transverse colon with a large 2 cm gallstone compressing her middle colic vessels. An extended right hemicolectomy was performed with a primary anastomosis. The importance of stone retrieval during laparoscopic cholecystectomy is emphasized.

Adult↗
PubMed2006

Laparoscopic repair of Morgagni hernia.

BACKGROUND: Morgagni hernia is a rare type of diaphragmatic hernia which represents less than 5% of all congenital diaphragmatic hernias. Patients are generally asymptomatic and are diagnosed incidentally. When symptomatic, it generates symptoms due to the compression of thoracic organs or compression of herniated intraabdominal organs. Once diagnosed, the condition requires prompt surgical correction. The defect is repaired either by primary suture or by the use of a prosthetic mesh. In adults, prosthetic mesh repair is preferred. Recently, laparoscopic repair of Morgagni hernia has been introduced and gained wide acceptance. MATERIALS AND METHODS: Between 2002 and 2004, 5 patients with Morgagni hernia were treated laparoscopically at our department. Female/male ratio was 3/2. Mean age was 56 years (range 41 to 69 y). Diagnosis were made by chest x-ray and CT scan. Herniation was on the left in 2 patients, and on the right in 3. The content of hernial sac was transverse colon and stomach. There were 2 separate defects in a patient with left-sided hernia. All cases were laparoscopically treated using prosthetic material. RESULTS: All operations were completed laparoscopically. The postoperative hospital stay was 3 to 5 days with a mean of 4 days. None of the patients developed any complication in the early postoperative period. The mean follow-up period is 7 months (range 3 to 24 mo). All patients are actually in good health and without recurrence. CONCLUSION: Laparoscopic repair of Morgagni hernia is a safe, simple, and reliable procedure which presents all the advantages of the minimally invasive surgery.

Adult↗
PubMed2004

Experience with coapted gastric tube outlet and composite gastrointestinal reservoir for continent cutaneous urinary diversion.

PURPOSE: Established techniques for urinary diversion are not ideal for certain patients such as those with extensive pelvic irradiation, metabolic acidosis, short bowel syndrome or renal insufficiency. In a multi-institutional study a gastrointestinal reservoir was previously found to provide metabolic balance in such patients. We used a coapted gastric tube as the continent outlet in patients undergoing gastrointestinal urinary diversion. We evaluate the long-term functional results of the gastric tube to provide continence and report our long-term followup results. MATERIALS AND METHODS: A composite reservoir was constructed from gastric and transverse colon or ileal segments. In addition, a gastric strip, in continuity with the gastric segment of the composite reservoir, was tubularized and coapted to provide the continence mechanism. RESULTS: A total of 19 patients with a gastrointestinal reservoir and coapted gastric tube outlet were followed for 24 to 101 months, of whom 18 are continent day and night on intermittent catheterization every 3 to 8 hours. Four of 34 ureters (12.5%) became obstructed. One patient had significant preoperative renal insufficiency, which progressed to end stage renal disease. Another patient had slow progression of renal insufficiency. In the remaining 17 patients mean serum creatinine did not change significantly while serum chloride and bicarbonate improved or remained normal. CONCLUSIONS: A coapted gastric tube functions well as the continence mechanism in patients with a gastrointestinal urinary reservoir. We also confirm the metabolic advantages of a composite gastrointestinal urinary reservoir. Gastrointestinal cutaneous urinary diversion can be an alternative to incontinent diversion in select patients who are not suitable for other forms of diversion.

Adult↗
PubMed2005

Does the less aggressive multimodal approach of treating bladder-prostate rhabdomyosarcoma preserve bladder function?

PURPOSE: The treatment of bladder-prostate rhabdomyosarcoma has evolved into multimodal therapy, including chemotherapy, radiotherapy and organ sparing surgery with bladder preservation. We investigated bladder function in children who underwent multimodal therapy at our institution and retained the original bladder for at least 6 months after treatment ended. MATERIALS AND METHODS: We evaluated 8 children with bladder-prostate rhabdomyosarcoma treated at our institution between 1999 and 2003 according to inclusion criteria. All patients underwent history, physical examination and urodynamic study at least 6 months after completion of treatment (range 6 to 39 months). RESULTS: All patients were treated following the same chemotherapy and radiotherapy scheme. Three patients (37.5%) were asymptomatic and had normal urodynamic studies, and 1 had only dysuria (this patient later underwent continent urinary diversion with transverse colon). The 4 remaining patients had urological complaints, and the urodynamic findings were reduced bladder capacity in 4, overactivity plus sensory urgency in 2, sensory urgency only in 1 and suprapubic pain during filling in 1. CONCLUSIONS: Among 8 patients 3 had normal urinary function and 4 had minor tolerable alterations. Cystectomy and urinary diversion were later necessary in only 1 patient due to disabling dysuria. The fact that the original functioning bladder was preserved in 7 of 8 patients suggests the feasibility of multimodal therapy. Long-term followup will still be necessary for definite conclusions, since we recognize that the deleterious effects, mainly of radiotherapy, may take longer to become evident.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

Intestinal obstruction caused by a strangulated Morgagni hernia in an adult patient.

A Morgagni hernia is a congenital herniation of abdominal contents into the thoracic cavity through a retrosternal diaphragmatic defect. The reported incidence of congenital diaphragmatic hernias is estimated to be 1 in between 2000 to 5000 births. Morgagni hernias comprise 2% of diaphragmatic hernias. Most Morgagni hernias are found and repaired in children, but 5% are found in adults. They are usually asymptomatic and often found incidentally on chest radiography. Symptoms of these hernias are attributable to the herniated viscera. Morgagni hernias containing bowel may require repair on presentation because of the risk of incarceration. We present a case of an incarcerated and strangulated Morgagni hernia in a 71-year-old woman admitted to our clinic for abdominal pain and symptoms of intestinal obstruction. The diagnosis was made preoperatively by chest radiography, sonography, and computed tomography. Emergent laparotomy was performed, with the herniated transverse colon and omentum reduced into the abdomen. The diaphragmatic defect was repaired, followed by resection of the strangulated omentum. In conclusion, a Morgagni hernia may cause intestinal obstruction. Routine radiographic studies are usually sufficient to arrive at the diagnosis, but a CT scan and sonography may be necessary. Laparotomy is appropriate for the management of symptomatic adult patients with Morgagni hernias, particularly those with findings of intestinal strangulation, with laparoscopic treatment an alternative approach in selected cases.

Aged↗